Management of Massive Hemoptysis: A Single Institution Experience

Introduction: Definition of massive hemoptysis is unclear: criteria range from 100cc /day to 1000cc over a few days. Massive hemoptysis is seen in 1.5 % of all hemoptysis cases. Deaths occurring by exsanguination or asphyxiation from flooding of the alveoli with blood and intractable hypoxemia. The 3 principles of management of hemoptysis consist: 1) maintain airway patency and oxygenation, 2) localize the source of bleeding, 3) control hemorrhage. Consider surgery for lateralized uncontrollable massive hemoptysis unresponsive to other measures or as a definitive therapy in patients whose hemoptysis and general medical condition have stabilized. Objective: Analyses of our experience in treatment of 24 patients with severe hemoptysis for in single thoracic surgery Unit in SU”Shefqet Ndroqi” Tirana, Albania. Material and Methods: In a 5-year period 2009-2013, twenty-four patients were admitted in our hospital with massive hemoptysis. All patients are estimated by: Physical examination, CXR, CT Chest, Bronchoscopy and Arteriography. Fifteen 15 (62%) patients received surgical resection as a definitive therapy. Results: Of twenty-four patients enrolling in the study 18 were males and 6 females, mean age 54.9±13,7 years. The underlying pathology included bronchiectasis (n=5), active tuberculosis (n=9), pneumomycosis (n=7), lung cancer (n=2) and pulmonaryhydatic cyst(n=1). Hemoptysis ceased with conservative management in 9 patients (38%) only. Fifteen 15 (62%) patients received surgical resection. The procedures included lobectomy (n=13), bilobectomy (n=1) and pneumonectomy (n=1). The in-hospital mortality after surgery was 4.1% (1) patient. Redu-thoracotomy and right axillary open window in one patient. Postoperative morbidity occurred in 4 patients, including prolonged ventilatory support, bronchopleural fistulae, empyema and myocardial infarction. Conclusions: The clinical outcome for massive hemoptysis reflects the generalized nature of a destructive disease process involving both lungs and a limited respiratory reserve. Surgery is associated with high risk of morbidity and mortality, and should be performed only in selected patients.Keywords: masive Hemoptysis, Chest, Bronchoscopy and Arteriography, bronchopleural fistulae, empyema and myocardial infarction

Risk factors for treatment failure and mortality among hospitalized patients with complicated urinary tract infection: A multicenter retrospective cohort study (RESCUING study group)

Background. Complicated urinary tract infections (cUTIs) are responsible for a major share of all antibiotic consumption in hospitals. We aim to describe risk factors for treatment failure and mortality among patients with cUTIs. Methods. A multinational, multicentre retrospective cohort study, conducted in 20 countries in Europe and the Middle East. Data were collected from patients' files on hospitalised patients with a diagnosis of cUTI during 2013-2014. Primary outcome was treatment failure, secondary outcomes included 30 days all-cause mortality,among other outcomes. Multivariable analysis using a logistic model and the hospital as a random variable was performed to identify independent predictors for these outcomes. Results. A total of 981 patients with cUTI were included. Treatment failure was observed in 26.6% (261/981), all cause 30-day mortality rate was 8.7% (85/976), most of these in patients with catheter related UTI (CaUTI). Risk factors for treatment failure in multivariable analysis were ICU admission (OR 5.07, 95% CI 3.18-8.07), septic shock (OR 1.92, 95% CI 0.93-3.98), corticosteroid treatment (OR 1.92, 95% CI 1.12-3.54), bedridden (OR 2.11, 95%CI 1.4-3.18), older age (OR 1.02, 95% CI 1.0071.03-), metastatic cancer (OR 2.89, 95% CI 1.46-5.73) and CaUTI (OR 1.48, 95% CI 1.04-2.11). Management variables, such as inappropriate empirical antibiotic treatment or days to starting antibiotics were not associated with treatment failure or 30-day mortality. More patients with pyelonephritis were given appropriate empirical antibiotic therapy than other CaUTI [110/171; 64.3% vs. 116/270; 43%, p <0.005], nevertheless, this afforded no advantage in treatment failure rates nor mortality in these patients. Conclusions. In patients with cUTI we found no benefit of early appropriate empirical treatment on survival rates or other outcomes. Physicians might consider supportive treatment and watchful waiting in stable patients until the causative pathogen is defined

Outcomes of Chronic Hepatitis C Treatment in The Infectious Diseases Hospital Iasi

Chronic hepatitis C is an important cause of morbidity and mortality due o hepatic disease. Material and method The retrospectively studied the evolution of 30 patients with chronic hepatitis C, treated in the Infectious Diseases Hospital of Iasi, with Peginterferon and Ribavirin for 48 weeks. Results 18 patients were treated with Peginterferon α2a and Ribavirin, and 12 with Peginterferon α2b and Ribavirin. Most of them (73.3%) were adults, aged between 30 and 50 years, with a sex ratio M/F – 13/17. Most of them had risk factors for the transmission of HCV: 28 of them suffered surgery and 2 of them had infected sexual partners. 3 patients didn’t achieve a rapid virusologic response and 6 patients were relapsers. All the other 70% of patients had a sustained virologic response. The side effects were present in all patients, with a moderate intensity. Conclusion The success (SVR) rate of antiviral therapy was higher than expected (especially for genotype 1 HCV). The patients with a viral relapse could be soon treated with the new protease inhibitors and hope for a cure